scholarly journals New Closure Method Using Loop and Open–Close Clips after Endoscopic Submucosal Dissection of Stomach and Colon Lesions

2021 ◽  
Vol 10 (15) ◽  
pp. 3260
Author(s):  
Akira Yoshida ◽  
Hiroki Kurumi ◽  
Yuichiro Ikebuchi ◽  
Koichiro Kawaguchi ◽  
Kazuo Yashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Opposite Edge ◽  
Closure Technique ◽  
En Bloc ◽  
Closure Rate ◽  
Colon Tumors ◽  
Submucosal Dissection ◽  
Complete Closure ◽  
Closure Method ◽  
Clip Closure

Endoscopic submucosal dissection (ESD) and en bloc resection of stomach and colon tumors have become common. However, mucosal defects resulting from ESD may cause delayed bleeding and perforation. To prevent adverse events, we developed a new clip closure technique, namely, the loop and open–close clip closure method (LOCCM), and aimed to examine its efficacy after ESD for stomach and colon tumors. The LOCCM uses loop and open–close clips. Here, the open–close clip was used to grasp the loop to bring it to the edge of the post-ESD mucosal defect. Another clip with a loop was then inserted into the opposite edge and clipped to the contralateral mucosa to pull both edges together. Once apposed, additional clips facilitated complete closure. The LOCCM was performed in 19 patients after ESD at Tottori University between October 2020 and March 2021. The outcomes retrospectively analyzed were the LOCCM success and adverse event rates. The complete closure rate using LOCCM was 89.5% and none of the patients had post-ESD bleeding or perforation. The results show that LOCCM is an effective and safe closure technique for mucosal defects after stomach and colon ESD to prevent bleeding and perforation.

scholarly journals Complete closure versus simple closure for perforations during colorectal endoscopic submucosal dissection

2020 ◽  
Vol 08 (01) ◽  
pp. E76-E80 ◽  
Author(s):  
Satoshi Kinoshita ◽  
Toshihiro Nishizawa ◽  
Ai Fujimoto ◽  
Hideki Mori ◽  
Yuichiro Hirai ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Similar Efficacy ◽  
Simple Closure ◽  
Muscular Layer ◽  
Inflammatory Reactions ◽  
Submucosal Dissection ◽  
Complete Closure ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
Closure Method ◽  
Closure Group

Abstract Background and study aims The efficacy of complete closure versus simple closure for perforations during endoscopic submucosal dissection (ESD) has never been evaluated. We evaluated the efficacy of complete closure and simple closure for perforations and muscular layer injuries incurred during ESD. Patients and methods Thirty-four consecutive patients who underwent “complete closure” or “simple closure” for correction of perforations and muscular layer injuries during colorectal ESD were enrolled in this study. Complete closure was performed by the mucosa-submucosa clip closure method using only conventional endo-clips. For simple closure, endo-clips are placed just for perforation or muscular layer injury, while leaving any mucosal defects open. Results Among the 15 patients in the complete closure group, eight developed perforations and seven developed muscular layer injuries. Among the 19 patients in the simple closure group, six developed perforations and 13 developed muscular layer injuries during the ESD procedure. There were no statistically significant differences between the two groups in inflammatory reactions, adverse events, or length of the hospital stay. Conclusion Complete closure and simple closure for perforations and muscular layer injuries during ESD seem to have similar efficacy. While simple closure for a perforation during ESD seems sufficient, further study will be required to confirm our results.

scholarly journals Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection

2020 ◽  
Vol 12 (1) ◽  
pp. 17-22
Author(s):  
Satoshi Kinoshita ◽  
Toshihiro Nishizawa ◽  
Ai Fujimoto ◽  
Hideki Mori ◽  
Yoshihiro Nakazato ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Closure Method ◽  
Clip Closure

scholarly journals Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection

2018 ◽  
Vol 06 (05) ◽  
pp. E582-E588 ◽  
Author(s):  
Hideharu Ogiyama ◽  
Shusaku Tsutsui ◽  
Yoko Murayama ◽  
Shingo Maeda ◽  
Shin Satake ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Exact Test ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Student’S T ◽  
Closure Group ◽  
Clip Closure

Abstract Background and study aims Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large superficial colorectal tumors, but delayed bleeding remains one of the most common complications of colorectal ESD. The aim of the present study was to evaluate the clinical efficacy of prophylactic clip closure of mucosal defects for the prevention of delayed bleeding after colorectal ESD. Patients and methods We enrolled consecutive patients with colorectal lesions between January 2012 and May 2017 in this retrospective study. In the early part of this period, post-ESD mucosal defects were not closed (non-closure group); however, from January 2014, post-ESD mucosal defects were prophylactically closed with clips when possible (closure group). The main outcome measured was delayed bleeding. Variables were analyzed using the chi-squared test, Fisher’s exact test, or Student’s t-test. Results Of 156 lesions analyzed, 61 were in the non-closure group and 95 in the closure group. Overall, delayed bleeding occurred in 5 cases (3.2 %). The delayed bleeding rate was 0 % (0/95) in the closure group and 8.2 % (5/61) in the non-closure group (P = 0.008). The mean procedure time for closure was 10.4 ± 4.6 min (range 3 – 26 min). Conclusions We demonstrated that prophylactic clip closure of mucosal defects might reduce the risk of delayed bleeding after colorectal ESD.

scholarly journals Technical feasibility of line-assisted complete closure technique for large mucosal defects after colorectal endoscopic submucosal dissection

2017 ◽  
Vol 05 (01) ◽  
pp. E11-E16 ◽  
Author(s):  
Minoru Kato ◽  
Yoji Takeuchi ◽  
Yasushi Yamasaki ◽  
Masamichi Arao ◽  
Sho Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Resected Specimen ◽  
Procedure Time ◽  
Closure Technique ◽  
Technical Feasibility ◽  
Submucosal Dissection ◽  
Complete Closure ◽  
Procedural Complications ◽  
Procedural Success ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims Complete closure of large mucosal defects after colorectal endoscopic submucosal dissection (C-ESD) is considered impossible in most cases because of the limited width of the open clip. We therefore invented a simple closure technique using clip-and-line, named “line-assisted complete closure (LACC)”, and assessed its technical feasibility. Patients and methods Between January and February 2016, we performed LACC in 11 patients after C-ESD and included them in this retrospective feasibility study. Outcome measures were procedural success rate, procedure time, and post-procedural complications. Results The median size of the resected specimen was 36 mm (range 30 – 72 mm). Procedural success was achieved in 10 of 11 cases (91 %). Those 10 cases required a median of 9 endoclips (range 6 – 12) for complete closure. Median procedure time for LACC was 14 minutes (range 6 – 22). No complications were observed in any of the cases after the procedure. Conclusion LACC is a simple and feasible technique for complete closure of large mucosal defects after C-ESD.

Balloon-assisted endoscopy facilitates endoscopic submucosal dissection of difficult superficial proximal colon tumors

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 800-808 ◽  
Author(s):  
Takeshi Yamashina ◽  
Yoshikazu Hayashi ◽  
Hirotsugu Sakamoto ◽  
Tomonori Yano ◽  
Yoshimasa Miura ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endoscopic Submucosal Dissection ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Proximal Colon ◽  
Bloc Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Colon Tumors ◽  
Submucosal Dissection

Abstract Background Colorectal endoscopic submucosal dissection (ESD) can be technically difficult in some situations, such as paradoxical movement of the proximal colon. The double-balloon endoscope provides stable endoscopic maneuvering, even in the small intestine. The aim of this study was to assess the outcomes of balloon-assisted endoscopic submucosal dissection (BAESD) of colonoscopically difficult superficial proximal colon tumors. Methods We retrospectively reviewed the records of patients who underwent BAESD of superficial proximal colon tumors where colonoscopic difficulties were encountered, from January 2011 to September 2016. Difficulties were defined as a previous incomplete colonoscopy using a conventional colonoscope or unstable endoscopic maneuverability around the tumor with a conventional colonoscope. A propensity score model was used as a secondary analysis to compare outcomes of the BAESD group with those of a non-BAESD group.  Results BAESD was performed on 63 tumors in 63 patients. En bloc resection was achieved for 62 tumors (98 %) and an R0 resection was achieved for 55 tumors (87 %). Propensity score matching analysis created 59 matched pairs from the BAESD and non-BAESD groups. There were no statistically significant differences between the two groups in en bloc resection (100 % vs. 100 %; P > 0.99), R0 resection (90 % vs. 93 %; P = 0.74), perforation (0 % vs. 2 %; P > 0.99) or postoperative bleeding (3 % vs. 0 %; P = 0.50). Conclusion Balloon-assisted endoscopy achieved safe and reliable ESD of colonoscopically difficult superficial proximal colon tumors.

New closure method for a mucosal defect after endoscopic submucosal dissection: the clip-on-clip closure method

Endoscopy ◽  
2018 ◽  
Vol 50 (05) ◽  
pp. 547-548 ◽  
Author(s):  
Tatsuma Nomura ◽  
Akira Kamei ◽  
Shinya Sugimoto ◽  
Jun Oyamada
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Mucosal Defect ◽  
Closure Method ◽  
Clip Closure

scholarly journals Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

2020 ◽  
Vol 08 (12) ◽  
pp. E1832-E1839
Author(s):  
Yuichiro Kuroki ◽  
Toshiyuki Endo ◽  
Kenta Iwahashi ◽  
Naoki Miyao ◽  
Reika Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Tumor Location ◽  
Proximal Colon ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

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